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General NPI Number Information
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NPI Number | 1821724873
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Entity Type | Individual
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Provider Name | JONATHAN PHAM OD
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Gender | Male
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 1800 FOURTH ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4454
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Country | US
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Telephone | 925-447-3883
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 SERPA DR
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City | MILPITAS
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State | CA
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Zip | 95035-4726
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Country | US
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Telephone | 408-806-6687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34882
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License Number State | CA
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